A Sensory-Motor Approach to CAS and Related Motor Speech Disorders: Why and How

Posted by Deborah Grauzam on

This presentation is going to be held at the Texas Speech-Language & Hearing Association 2017 Annual Convention, Thursday. Feb. 23, noon-1:30 p.m.

Author: Renee Roy Hill, MS, CCC-SLP

Abstract:

Discuss treatment of clients diagnosed with apraxia of speech and related motor speech disorders. Explore 1) Childhood Apraxia of Speech 2) Related Motor Speech Disorders 3) Van Riper’s Phonetic Placement Approach 4) the importance of tactile and proprioception in shaping speech movements for speech, 5) shaping placement of the articulators using tools.

Learning outcomes: 

  1. Participants will be able to list at least three characteristics of Childhood Apraxia of Speech and Dysarthria.
  2. Participants will be able to list at least two goals of a tactile treatment approach.
  3. Participants will be able to implement three phonetic placement methods.

Summary: 

Children with motor based speech disorders such as Dysarthria and Childhood Apraxia of Speech (CAS) present with a speech sound disorder in which precision and consistency of movements underlying speech are impaired. CAS may impact both non-speech and speech movements. CAS may also coexist with disorders of muscle strength and tone such as dysarthria. As infants and toddlers, children with CAS may have limited babbling, limited expression, but seemingly typical receptive skills. Older children with CAS may have poor oral imitation skills, erratic speech sound errors, and lack of a verse phonemic repertoire (Kaufman 2013).  Unfortunately, there is no specific, validated list of diagnostic features of CAS which differentiates this disorder from other types of speech sound disorders (ASHA, 2007), however the research is emerging. 

This presentation will attempt to identify key diagnostic features of both CAS and Dysarthria and discuss when Oral Placement Therapy (OPT) may be beneficial.  While it is always the goal to work on verbal output and speech production, some children with CAS have such severe motor planning issues, or co-morbid muscle based issues that they are non-verbal, or have very limited verbal output. Tactile cueing techniques such as PROMPT (Grigos,2010), or The Kaufman Speech Praxis Therapy (Kaufman, 2007) may prove positive results for some children; however others may need even more work on the sensory-motor system to gain foundational skills necessary for speech (Kaufman, 2007). Kaufman suggests that in order for these therapies to be successful, the child must be able to imitate, sit and attend, and execute gross motor movements on command. In addition, oral motor weakness should not be the primary disorder. For these children, sensory integration, oral motor stretching and toning and speech sound shaping may be needed (Kaufman 2007). There is no question that working on oral-motor skills should not be done is isolation of speech production when dealing with apraxia (Marshalla, 2000), but rather as Oral Placement Therapy (OPT) which is a term suggested by Bahr and Rosenfeld Johnson (2010.)

OPT is a modern extension of Phonetic Placement Therapy (Van Riper, 1954) and The Feedback Model (Mysak, 1971). It is based on a very common sequence (Bahr 2001, Crary 1993, Hayden 2004, Marshalla 2004, Rosenfeld Johnson 1999, 2009, Young and Hawk 1955):   

  • Facilitate speech movement with the assistance of a therapy tool (ex. horn, tongue depressor) or a tactile-kinesthetic facilitation technique (ex. PROMPT facial cue);
  • Facilitate speech movement without the therapy tool and/or tactile-kinesthetic technique (cue fading);
  • Immediately transition movement into speech with and without therapy tools and/or tactile-kinesthetic techniques.

For children with motor speech disorders, this sequence can be helpful if the child cannot form the necessary placement of the articulators to produce sounds. Repetition and reinforcement is helpful based on motor learning theory (Hammer, 2007; Mysak 1971.) To improve speech, one must work on speech (Jakielski, 2007); however one must consider those children who have very limited verbal output (Merkel-Walsh, 2012).

The concept of “bridging” which is movement to speech based on muscle memory is an effective therapy technique (Roy-Hill, 2013). For example if a child has limited lip rounding to produce a /w/ , blowing bubbles can be used to reinforce lip rounding through tactile cueing, and as soon as movement is noted the tool is faded (Van Riper 1958) and speech sound drills can begin.

Clinicians must use evidenced based practice (EBP) to determine therapeutic treatment (ASHA, 2005). It is important to remember that EBP is not only limited to double blind studies, but an “approach in which current, high-quality research evidence is integrated with practitioner expertise and client preferences and values into the process of making clinical decisions (ASHA, 2007). Client progress and clinical data are important factors when determining treatment, and certainly the Phonetic Placement Approach (Van Riper , 1957) has been widely documented in the field of speech pathology. In addition, sensory-motor and oral tactile teaching techniques have clinical data to support their use (Bathel, 2007; Bahr & Rosenfeld-Johnson, 2010). Through muscle and motor based placement skills , therapists can effectively improve speech clarity in children who present with CAS. 

References:

American Speech-Language-Hearing Association. (2007). Childhood apraxia of speech [Technical report] available from www.asha.org/policy

Bahr, D., Rosenfeld-Johnson, S. (2010). Treatment of Children With Speech Oral Placement Disorders (OPDs): A Paradigm Emerges. Communication Disorders Quarterly, XX(X), 108.

Lof, G.L. (2007). Reasons why non-speech oral motor exercises should not be used for speech sound disorders. Presentation at the ASHA Annual Convention, Boston, MA. Nov. 17.

Roy-Hill, R. (2013). A Sensory-Motor Approach to Apraxia of Speech and Related Motor Speech Disorders [Live presentation].

Van Riper, C. (1958, 1954, 1947) Speech Correction: Principles and Methods. Englewood Cliffs: Prentice-Hall.

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Brain Stem Stroke: A Case Study

Posted by Deborah Grauzam on

This case study was originally posted in Advance for Speech & Hearing on November 14, 2016. Retrieved from http://speech-language-pathology-audiology.advanceweb.com/Features/Articles/Brain-Stem-Stroke-A-Case-Study.aspx

Author: Gabrielle Zimmer, MS, CCC-SLP

Brain Stem Stroke: A Case Study

Rebuilding communication one subsystem at a time.

Where do you start when a client understands everything that is said but has no way to communicate back to you? He cannot speak, gesture or write. How can you improve his quality of life?

As speech-language pathologists in the outpatient department at Kessler Institute for Rehabilitation, we frequently encounter challenging situations and provide treatment for medically complex adults who have suffered acquired and traumatic brain injuries (TBIs). To maximize each client’s potential, collaboration with an interdisciplinary team, including physicians, therapists and other specialists, is crucial. The implementation of a variety of treatment approaches based on the individual needs of the client is also critical.

An example of a complex case in which collaboration was necessary is the case of Ben, a 38-year-old male who began feeling right upper extremity twitching and slurred speech. This evolved and progressed and an MRI revealed a severe brainstem stroke. Ben was ultimately diagnosed with Locked-In Syndrome. He was unable to move any part of his body, although his receptive and expressive language and cognition remained entirely intact. He remembers hearing and understanding all that was being said at his bedside, but he was unable to express himself in any way with the exception of eye blinking. Ben recounted his inability to make requests such as to turn on the fan, feed him ice chips or scratch an itch.

Familiar Voice

Ben completed acute inpatient rehabilitation at Kessler and progressed to a state in which he could move his neck and to a small degree his mouth, lips and tongue. By using the eye gaze access feature of a high technology augmentative and alternative communication (AAC) speech generating device, Ben was able to demonstrate to his family members for the first time since his stroke that “he was in there.” This allowed him to communicate his wants and needs, ask questions and express concerns. He was an excellent candidate for an AAC device, but strived to speak in his own voice. Ben achieved his swallowing goals and was beginning to target phonation when he was discharged from inpatient therapy and transitioned to my care in the outpatient department.

When Ben started outpatient therapy, he had significantly reduced breath support, severely reduced tongue, lip, cheek and jaw movement, and was aphonic and unintelligible. He had difficulty changing his facial expressions to convey emotion and was unable to manage his saliva. He required 24/7 supervision and assistance and was unable to verbally communicate his basic wants and needs. Initially, I trialed traditional approaches to improve articulatory movement as well as voice exercises but quickly felt like we were hitting a wall. I felt it was necessary to break down and target each speech subsystem to maximize his abilities.

Tactile Approach

I sought an evaluation from an otolaryngologist who specializes in voice disorders to examine the integrity of his vocal cord movement which proved to be within normal limits. The difficulty appeared to be with the coordination of inhalation and exhalation for productive voicing as well as a resonance disorder due to limited velar movement. Volitional diaphragmatic breathing was challenging and most of his air was lost through his nasal cavity.

Knowing that his vocal cords were functioning properly was promising for the goal of achieving consistent voicing going forward. We used a spirometer for visual feedback and to target consistent volitional inhalation and exhalation for speech. Additionally, we consulted with a prosthodontist to further examine Ben’s palatal movement and to assess his candidacy for prosthesis. Ben was deemed a viable candidate and use of the palatal lift helped improve voicing and increased his volume. Now that voicing was becoming more consistent and breath support was improving, our goals shifted to articulatory movement and intelligibility.

Initially, Ben attempted to mouth single letters and words for lip reading. With such poor movement of his cheeks, lips and tongue, success was inconsistent and extremely frustrating for both Ben and his family. A tactile approach was deemed necessary for this case. I implemented two excellent therapeutic interventions – the Beckman Oral Motor Protocol and oral placement therapy with Talk Tools. The Beckman Oral Motor Protocol provided assisted movement to activate muscle contraction and movement against resistance to build strength and increased control of movement for the lips, cheeks, jaw, and tongue.

This was done in conjunction with a variety of hierarchical oral placement therapy techniques with Talk Tools, such as the jaw grading bite block, bubble blowing, horn blowing, velar grading and straw hierarchies, among others.

Improved Articulatory Movement

The initial tactile-kinesthetic feedback was crucial and contributed to improved articulatory movement. All oral placement tasks were paired with functional speech tasks. Ben began to increase intelligibility starting at the single word level, progressed to the basic phrase level and subsequently advanced to the sentence level. In addition, although Ben was tolerating a regular solid diet with thin liquids, he had self-established habitual patterns to compensate for his limited tongue and lip movement. The treatment approaches that were initially sought to improve his articulatory movement for speech simultaneously improved his feeding and swallowing function as well.

Ben progressed from an aphonic state to demonstrating increasingly controlled respiration for consistent phonation at the conversation level. Focus shifted to improve volume, pitch and vocal quality. His articulatory movement was severely limited, and he improved to the point where he produced intelligible sentences. Carryover was targeted outside of the speech therapy treatment room with collaboration between his physical and occupational therapists. He targeted speech goals to maintain phonation and intelligibility in different positions such as standing upright, lying on his back and during facilitated movement.

This same person who initially relied on an AAC device was now able to gradually participate in conversation using his own voice and his personality emerged. I began to learn about Ben’s interests, such as his skill at trivia, opinions on television shows and sarcastic sense of humor. He achieved major milestones, which included his abilities to participate and self-advocate in doctors’ appointments, hold conversations with his wife out to dinner and contribute to group conversation. His independence increased and required less caregiver support as he could call for help if needed.

Maximizing Abilities

In a complex case like Ben, utilizing a variety of treatment approaches was crucial to his progress and success. It is important to create individualized treatment programs that are comprehensive and functional for the client. The key to maximizing the client’s abilities is maintenance of well-rounded continuing education, implementation of strong evidence-based practice, collaboration within an interdisciplinary rehabilitation team and daily completion of a home exercise program for carryover outside of the therapy setting. This is in combination with time and dedication from the client and their support system. Ben said it best, “You can sit back and wait for a miracle, or you can make one happen. Let’s make a miracle!”

Resources

1: Beckman, D.A., (1994, Rev. 2010). Beckman Oral Motor Assessment and Intervention. Published by Beckman & Associates, Inc., 620 N Wymore Rd, Suite 230, Maitland, Florida 32751-4253. www.beckmanoralmotor.com

2: Rosenfeld-Johnson, S. (2014). A Therapist Guide to Rehabilitative Feeding and Speech Techniques for Teens and Adults: TalkTools, Charleston, SC.
Gabrielle Zimmer, MS, CCC-SLP is a speech-language pathologist and clinical specialist at Kessler Institute for Rehabilitation in West Orange, New Jersey.

Top-ranked by U.S.News & World Report for the 23rd consecutive year, Kessler Institute is the only rehabilitation hospital in New Jersey to be named to the prestigious list of “America’s Best Hospitals” and is the leading center of its kind in the East.

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Tongue Ties and Speech Sound Disorders: What Are We Overlooking?

Posted by Deborah Grauzam on

“The conversation for tongue tie in the speech pathology community is growing louder among some groups of speech-language pathologists (SLPs) (ASHA Leader, 2015). An ASHA literature search has suggested a correlation between tongue ties and difficulty producing lingual alveolar phonemes (Merkel-Walsh & Jahn, 2014). Furthermore, Eschler, Klein, and Overby (2010) indicated that SLPs’ diagnostic criteria, treatment, goals, and discharge criteria for ankyloglossia differ depending on comorbid behavior (i.e., SSDs or feeding/swallowing difficulty).

Recently, there is a rise in the identification of posterior tongue ties in infants who are having trouble feeding and toddlers/adolescents who are exhibiting continuous speech sound errors despite years of speech-language pathology services. Posterior ankyloglossia is characterized by a thickened frenulum (Type III) or a submucosal frenulum visualized as a flat, broad mound absent of any typical protruding frenular tissue, and restricts movement at base of tongue (Type IV) (Kutlow, 2011).”

Meaux, A., Savage, M., & Gonsoulin, C. presented the poster “Tongue Ties and Speech Sound Disorders: What Are We Overlooking?” at the 2016 Annual ASHA Convention, November 17-19 in Philadelphia, PA.

View the full poster here

Authors: Ashley Meaux, PhD, CCC-SLP, Meghan Savage, PhD, CCC-SLP, & Courtney Gonsoulin, MA, CCC-SLP

TalkTools | Tongue Ties and Speech Sound Disorders

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Diet-Shaping for Self-Limited Diets in Children With a Diagnosis of Autism Spectrum Disorder

Posted by Deborah Grauzam on

This article was initially presented at the 2016 Annual ASHA Convention, Thursday, November 17, 2016, 4:30-5:30 PM. It is available in video in full on Facebook: Part 1 / Part 2

Authors:

Robyn Merkel-Walsh MA, CCC-SLP

Lori Overland MS, CCC-SLP/C-NDT

Learner Outcomes:

1. Participants will have an improved understanding of the etiology of a self-limited.

2. Participants will be able to demonstrate understanding of a home-based diet.

3. Participants will be able to comprehend the concept of diet-shaping.

Discussion of Topic:

The CDC (2015) reports, that Autism Spectrum Disorder (ASD) impacts 1 in 68 children in the United States. In “cluster” states such as New Jersey, as many as 1 in 28 boys are affected.

Children with ASD often present with comorbid feeding issues. There is empirical evidence and an overall scientific consensus supporting an association between food selectivity and ASD (Marí-Bauset Zazpe, Mari-Sanchis, Llopis-González & Morales-Suárez-Varela, 2014). Problems with eating often occur before the actual diagnosis of ASD, and clinicians may often be alerted to the disorder when eating problems, nutritional concerns and gastrointestinal problems occur (Beckman & Cole-Clark, 2015).

Studies show that up to seventy percent of children with ASD are selective eaters and up to ninety percent have feeding problems (Volkert & M Vaz, 2010). Children with ASD are significantly more likely to refuse foods based on texture/consistency (77.4% vs 36.2%), taste/smell (49.1% vs 5.2%), mixtures (45.3% vs 25.9%), brand (15.1% vs 1.7%), and shape(11.3% vs 1.7%), (Hubbard, Anderson, Curtin, Must & Bandini,2014). Researchers at Marcus Autism Center and the Department of Pediatrics at Emory University School of Medicine conducted a comprehensive meta-analysis of published, peer-reviewed research relating to feeding problems and autism. Examination of dietary nutrients showed significantly lower intake of calcium and protein and a higher number of nutritional deficits overall among children with ASD (Korschun & Edwards, 2013). Feeding challenges in the Speech-language pathologists receive referrals for feeding issues in ASD both before and after diagnosis (Keen. 2008).

Applied Behavioral Analysis (ABA) has the most empirical research in treating ASD to date. Behavior analysis is a scientifically validated approach to understanding behavior and how it is affected by the environment (Lovaas & Smith, 1989). It has been endorsed by a number of state and federal agencies, including the U.S. Surgeon General and the New York State Department of Health (Iovannone, Dunlap, Huber, & Kincaid, 2003). Research has shown that ABA therapy is effective at increasing appropriate behaviors and decreasing inappropriate behaviors (Kodak & Piazza, 2008). Therefore, it is reasonable to believe the principles on which ABA techniques are based can help with feeding issues (Volkert & M Vaz, 2010). The problem is that behavioral therapies however, do not often take into account the complexity of the sensory-motor system or medical issues, and how they relate to self-limited diets in children with ASD. Behavioral components may be essential in a feeding program; however, they should be implemented in conjunction with a sensory-motor approach to prove the most positive outcomes.

An infant’s first “job” in life is self-regulation and modulating arousal. These hard-wired synergies impact the sensory-motor system and oral-motor development (Overland & Merkel-Walsh, 2013). Many children with autism have significant issues with arousal and self-regulation which drives behavioral responses (Barthels, 2014.) Many children with autism also have qualitative differences in motor skills, especially with posture and alignment. (Teitelbaum, 1998). These differences in motor skills may also impact the motor skills for safely handling food. Therefore, when an individual with autism is referred to a speech-language pathologist (SLP) for self-limited diet, a comprehensive feeding assessment is required, including: review of child’s medical status; gross, fine, and oral-motor development; nutritional status; and sensory processing (Arvedson & Brodsky, 2001). For example, 59 percent of autistic children who were undergoing endoscopy for GI symptoms had carbohydrate digestive abnormalities, compared with only 11 percent in unaffected children undergoing endoscopy for GI symptoms (Beckman & Cole-Clark, 2015). Issues that affect the variety in the diet may not be behavioral. Since the sensory and motor systems cannot be separated (Morris & Klein, 2000), it is very important to task analyze the child’s motor skills and how they relate to feeding before assuming that a self-limited diet is purely behavioral (Beckman & Cole-Clark, 2015; Merkel-Walsh & Overland, 2016).

Sensory processing issues can also contribute to feeding disorders (Twachtman-Reilly, Amaral, & Zebrowski, 2008). Sensory processing refers to the ability to receive messages from the senses, interpret and organize the information in order to turn it in to an appropriate motor or behavioral response. Not all children with sensory processing disorders have autism but more than ¾ or as many as 90% of children with a diagnosis of autism have some degree of sensory processing disorder (Schoen, Miller, Brett-Green & Nielsen, 2009). Children with sensory regulation disorder may not be able to organize themselves for feeding. Those with oral sensory issues may not feel the food in their mouths, or they may be overly sensitive to the feeling of the food in their mouths. They may not feel hunger or satiation. Sensory defensiveness produces a neurochemical reaction of fear that quickly becomes a hardwired automatic response. The nervous system triggers a “fright-flight-fight” response even if it is irrational (Merkel-Walsh & Overland, 2016). In addition, once a behavior is inadvertently reinforced, the behavior will reoccur (Brophy, 2013). Children with autism are at a higher risk for these problems, because many children with autism engage in ritualistic behaviors. Seemingly well-meaning parents and therapists may not realize that by reacting to food refusals they are actually increasing the chance for this behavior to reoccur (Brophy, 2013; Merkel-Walsh & Overland, 2016).

In clinical practice the speech-language pathologist needs to look at how the child with ASD reacts to touch of the extremities, the face, and oral cavity as well as oral habits such as teeth grinding, mouthing objects and eating items other than foods. A diet analysis is needed to assess if the child has intolerances to certain tastes, temperatures and textures. This will establish the child’s home base and provide a starting point for diet expansion. The therapist must look at the underlying oral sensory-motor skills to support safe, effective nutritive feeding (Merkel-Walsh & Overland, 2016).

In conclusion, children with ASD are prone to self-limited diets. In order for a speech and language pathologist to thoroughly assess and treat this disorder, the therapist must be in tune to the sensory-motor system and design a treatment plan based on the home base, and systematically and sequentially via diet- shaping.

References:

Arvedson, J. C. & Brodksy, L. (2001). Pediatric swallowing and feeding: Assessment and management (2nd Ed.). Albany, NY: Singular.

Barthels, K. (2014). There is always a reason for behavior: is it sensory or is it behavior? (Live presentation), New York, NY.

Beckman, D. & Cole-Clark, M. (2015). Diet texture transition for individuals with autism. American Speech Language Hearing Association, Denver, CO. Retrievable: http://www.beckmanoralmotor.com/media/Diet-Texture-Progression-for-Individuals-with-Autism-ASHA.pptx

Brophy, N. (2013). Behavior plan implementation in the classroom. (Power point slides), Ridgefield, NJ.

Center for Disease Control (2015). Autism Spectrum Disorders (ASDs). Retrieved from http://www.cdc.gov/ncbddd/autism/data.html

Fisher, A. G., Murray, E. A., & Bundy, A. C. (1991). Sensory integration: Theory and practice. Philadelphia, PA: F. A. Davis.

Gisel, E. G. (1994). Oral-motor skills following sensorimotor intervention in the moderately eating impaired child with cerebral palsy. Dysphagia, 9, 180-192.

Hubbard, K.L., Anderson, S.E., Curtin, C. Must, A. & Bandini, L.G. (2014). A comparison of food refusal related to characteristics of food in children with autism spectrum disorder and typically developing children, Journal of the Academy of Nutrition and Dietetics, Vol.114 (12), pp.1981-1987.

Iovannone, R. et al. (2003). Effective educational practices for students with autism spectrum disorder. Focus on autism and other developmental disabilities, 10883576,18,3.

Keen, D.V. (2008). Childhood autism, feeding problems and failure to thrive in early infancy, European Child & Adolescent Psychiatry, Vol.17 (4), pp.209-216.

Korschun, H., & Edwards, C. (2013.) Retrieved from http://www.news.emory.edu/stories/2013/02/autism_nutritional_deficits/

Kodak, T. & Piazza, C.C. (2008). Assessment and behavioral treatment of feeding and sleeping disorders in children with autism spectrum disorder. Behavior Modification, 33: 520-536.

Lovaas, O. I. & Smith, T. (1989). A comprehensive behavioral theory of autistic children: Paradigm for research and treatment. Journal of Behavioral Therapy and Experimental Psychiatry, 20, 17-29

Marí-Bauset, S., Zazpe, I., Mari-Sanchis, A., Llopis-González, A. & Morales-Suárez-Varela, M. (2014). Food selectivity in autism spectrum disorders, Journal of Child Neurology, 2014, Vol.29 (11), pp.1554-1561.

Merkel-Walsh, R. & Overland, L.L. (2016). Self-limited diets in children with a diagnosis of autism spectrum disorder. Oral Motor Institute. Vol 5, Monograph 7. Retrieved from: http://www.oralmotorinstitute.org/mons/v5n1_walsh.html

Morris, S. E., & Klein, M. D. (2000). Pre-feeding skills: A comprehensive resource for mealtime development. San Antonio, TX: Therapy Skill Builders.

Overland, L.F. & Merkel-Walsh, R. (2013). A sensory-motor approach to feeding. Charleston, SC. TalkTools.

Schoen, S., Miller, L.J., Brett-Green, B.A. & Nielsen, D.M. (2009). Physiological and behavioral differences in sensory processing: a comparison of children with autistic spectrum disorder and sensory modulation disorders, Frontiers in Integrative Neuroscience, Vol. 3, Article 29, 1-11

Teitelbaum, P., Teitelbaum, O., Nye, J., Fryman, J.& Mauer, R. (1998). Movement analysis in infancy may be useful for early diagnosis of autism. Psychology, 95:23, 13982-13987

Twachtman-Reilly, J., Amaral, S.C. & Zebrowski, P. P. (2008). Addressing feeding disorders in children on the autistic spectrum in school based settings: Physiological and behavioral issues. Language Speech and Hearing Services in Schools, 39, 261-272.

Volkert, V.M. & M Vaz, P.C. (2010). Recent studies on feeding problems in children with autism. Journal of Applied Behavioral Analysis, 43 (1), 155-159.

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Performing a VFSS that Communicates Positive Results: Adult and Pediatric Patients

Posted by Deborah Grauzam on

We are delighted to share with you a description of TalkTools® Instructor Jennifer Jones's four-hour presentation at the annual MSHA Convention, March 3, 2016.

"Performing a VFSS that Communicates Positive Results: Adult and Pediatric Patients"

By Jennifer Jones, Ph.D., CCC-SLP, BCS-S, C/NDT

ABSTRACT

The VFSS is the standard for instrumental evaluation of swallowing disorders, but if clinicians don't communicate the appropriate results then the receiving therapist cannot properly treat the patient. Participants will watch many VFSS and identify abnormal and normal physiology utilizing interactive technology, discuss positive attributes of a disordered swallow and plan treatment.

OBJECTIVES

  1. Identify 2 disorders each that could occur before, during and after the swallow.
  2. List 3 normal and appropriate physiologic attributes of the VFSS viewed.
  3. Discuss positive attributes of disordered swallows and plan appropriate treatment.

As Clinicians, we are taught to find the things that are “wrong” with our patients. When we write a language and/or swallowing report we document all of the things that our patient cannot do.  We are trained to see what is disordered or abnormal and we document those findings. However, there are positive attributes that should be reported as well. We need to see the positives that our patients have to offer, either through language or swallowing.

This course is created based on research that shows the normal aging process with swallowing, which is coined Presbyphagia. Are our patients being diagnosed with moderate and severe dysphagia based on normal aging changes to the swallowing anatomy and physiology? Are there patients who are on limited diets based on normal aging difficulties with swallowing? This course will teach attendees about the normal aging process and how to discern normal from abnormal physiology in the aging population.

The Videofluoroscopic Swallow Study is a means to discover what our patients can eat and drink safely with minimal risk and minimal invasion to their quality of life.  In order to achieve this goal, we must be able to discern the positive aspects of a patient’s swallow so that we can build on it. A swallow study should not be considered complete until there is some consistency that a patient can eat or drink safely with minimal invasion.  If a therapist can focus more on the positive aspects of the swallow then designing a treatment plan utilizing those aspects would be less invasive.

This course involves utilizing an audience response system so that participants can be interactive with the speaker. The speaker will present greater than 15 VFSS (the # depends on allotted time) for interpretation.  The VFSS will be discussed and participants will be presented with a question and multiple answers.  The participants will be required to answer these questions using the audience response system, which will require them to commit to an answer.  When we perform the VFSS we commit to answers rather quickly, which is what changes our on-line modifications during the VFSS. The participants will be required to answer questions related to normal and abnormal physiology, positive attributes and planning treatment. Upon completion of this course, participants will have reviewed multiple swallow studies and observed that positive attributes should be utilized to plan treatment.

If you missed it, meet Jennifer Jones June 24-25 in San Juan, PR for her live workshop: "Pediatric Dysphagia: Interpreting the MBSS and Planning Treatment."

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